Kidney Article Part 3 — Biomarkers and Measurement
One of the most powerful ideas in cellular medicine is that the “invisible” can be made visible. The pathways and dominoes that tumble inside our cells aren’t just abstract concepts—they leave fingerprints that can be measured. Biomarkers are those fingerprints. They are the translation between mechanistic stress and clinical awareness, the way we can peer inside the dance of mitochondria, immune tone, vascular health, and repair. In kidney disease, the biomarker story tells us exactly how the first domino set the others into motion. Think first of redox balance. When mitochondria lean too heavily on glycolysis and electron flow becomes inefficient, NAD+ pools drain and NADH builds. The NAD+/NADH ratio is the gold-standard reflection of redox status, showing whether the cell is running smoothly on oxidative phosphorylation or choking on excess reducing equivalents. A low ratio means sirtuins like SIRT1 and SIRT3 are silenced, leaving DNA less protected and repair less efficient. It’s like a city that once had a thriving team of repair crews, now sitting idle because their wages dried up. Alongside this, the lactate-to-pyruvate ratio offers a more accessible proxy. High lactate with relatively low pyruvate tells us glycolysis has become dominant, confirming that cells are leaning on the quick-and-dirty survival pathway rather than efficient respiration. As the imbalance spreads outward, we can track inflammation. hsCRP is a workhorse biomarker here. Elevated levels tell us that NF-κB has been turned on, driving a persistent inflammatory tone. But hsCRP alone is blunt—it’s like knowing a fire alarm is ringing but not knowing which room the fire is in. Cytokine panels offer more nuance: IL-6 and TNF-alpha elevations confirm pro-inflammatory dominance, while low IL-10 shows that resolution is missing. In kidney disease, this trio tells us not just that inflammation is present, but that it is locked into the maladaptive side of the cycle. The vasculature offers its own set of clues. Nitric oxide metabolites can be measured directly, reflecting endothelial flexibility. Low NO levels indicate that PI3K/AKT and eNOS are faltering. Flow-mediated dilation (FMD), a functional vascular test, demonstrates whether blood vessels can widen smoothly in response to increased flow. Poor FMD is a functional echo of what is happening in the kidney’s glomeruli: rigid vessels transmitting mechanical stress downstream. Add in ICAM and VCAM, adhesion molecules that rise when endothelial walls are inflamed, and you have a detailed map of how the traffic lights of circulation are failing.